Citation Nr: 21040273 Decision Date: 07/03/21 Archive Date: 07/03/21 DOCKET NO. 16-09 139 DATE: July 3, 2021 ORDER An initial rating of 70 percent for adjustment disorder since October 24, 2013, is granted. An initial rating of more than 10 percent for degenerative arthritis of the left patellar articular margin since October 24, 2013, is denied. An initial rating of 10 percent for left knee instability since October 24, 2013, is granted. A total rating for compensation purposes based on individual unemployability due to service-connected disabilities (TDIU) is granted. REMANDED The issue of an effective date prior to October 24, 2013, for the grant of service connection for left shoulder (minor) partial thickness supraspinatus tear is remanded. The issue of an effective date prior to October 24, 2013, for the grant of service connection for left peroneus brevis tear is remanded. The issue of an effective date prior to October 24, 2013, for the grant of service connection for narcolepsy without cataplexy is remanded. The issue of an effective date prior to October 24, 2013, for the grant of service connection for adjustment disorder is remanded. The issue of an effective date prior to October 24, 2013, for the grant of service connection for degenerative arthritis of the left patellar articular margin is remanded. The issue of an effective date prior to October 24, 2013, for the grant of service connection for atypical chest pain is remanded. The issue of an effective date prior to October 24, 2013, for the grant of service connection for small hepatic cyst is remanded. The issue of an effective date prior to October 24, 2013, for the grant of service connection for left ankle scar is remanded. FINDINGS OF FACT 1. Since October 24, 2013, the Veteran has had occupational and social impairment with deficiencies in most areas. 2. The Veteran has had slight left knee instability since October 24, 2013. 3. The Veteran's left knee limitation of motion is noncompensable, but he has had arthritis since October 24, 2013. 4. The Veteran's service-connected disabilities prevent him from securing or following a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for an initial rating of 70 percent, since October 24, 2013, for adjustment disorder have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.7, 4.14, 4.130, Diagnostic Code 9440. 2. The criteria for an initial rating of more than 10 percent since October 24, 2013, for degenerative arthritis of the left patellar articular margin have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5260, 5261. 3. The criteria for an initial rating of 10 percent since October 24, 2013, for left knee instability have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5257. 4. The criteria for a TDIU have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.326(a), 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the U.S. Army from October 2004 to December 2005 and from October 2006 to October 2013. He had additional service in the U.S. Army Reserve. He served in Southwest Asia. Increased Ratings Disability evaluations are determined by comparing the Veteran's current symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided. Separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other condition. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). Where, as here, the issues involve the assignment of an initial rating for a disability following the award of service connection for that disability, the entire history of the disability must be considered. See Fenderson v. West, 12 Vet. App. 119 (1999). 1. Entitlement to an initial rating of more than 30 percent from October 24, 2013 to November 9, 2016, and of more than 50 percent since November 10, 2016, for adjustment disorder. A 30 percent rating is warranted for adjustment disorder where there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating requires occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating requires occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood due to symptoms such as suicidal ideation, obsessional rituals which interfere with routine activities, intermittently illogical, obscure, or irrelevant speech, near continuous panic or depression affecting the ability to function independently, appropriately and effectively, impaired impulse control (such as unprovoked irritability with periods of violence), spatial disorientation, neglect of personal appearance and hygiene, difficulty in adapting to stressful circumstances (including work or a work like setting), and an inability to establish and maintain effective relationships. A 100 percent rating requires total occupational and social impairment due to symptoms such as gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, a persistent danger of hurting himself or others, an intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene), disorientation to time or place, and memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, Diagnostic Code 9440. The use of the phrase "such symptoms as," followed by a list of examples, provides guidance as to the severity of symptomatology contemplated for each rating. In particular, use of such terminology permits consideration of items listed as well as other symptoms and contemplates the effect of those symptoms on the claimant's social and work situation. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). The Veteran has non-service-connected psychiatric disorders, in addition to his service-connected adjustment disorder. No competent medical professional has separated the effects of the non-service-connected disorders from those associated with the service-connected disorder. Therefore, all of the Veteran's psychiatric symptoms will be attributed to his service-connected adjustment disorder. See Mittleider v. West, 11 Vet. App. 181 (1998) citing Mitchem v. Brown, 9 Vet. App. 136, 140 (1996) (holding that when claimant has both service connected and non-service-connected disabilities, Board must attempt to discern the effects of each disability and, where such distinction is not possible, attribute such effects to the service-connected disability). In November 2012, prior to service separation, the Veteran was afforded a VA examination. He reported that he was married for the second time, that his spouse lived in another part of the country, and they saw each other once per year but exchanged text messages daily. He attended church and spent time with other church members. He participated in no leisure activities. He had been hospitalized in July 2012 for mental health treatment, including suicidal ideation. The examiner found that he was clean and neatly groomed, and cooperative and friendly. The examiner also noted that his affect was appropriate, his mood was anxious, and that he had no delusions, hallucinations, panic attacks, episodes of violence, or homicidal or suicidal ideation. He was able to maintain his personal hygiene and had no problems carrying out activities of daily living. A November 2012 VA general medicine examination indicates a history of depression, memory impairment, anxiety, and sleep impairment. The record indicates that the Veteran had VA Veteran Readiness & Employment (VR&E) benefits from August 2013 to May 2014; that he was enrolled at a university in spring of 2015 for accounting; and that he was enrolled at a different university in spring of 2016. In April 2015, the Veteran was afforded a VA posttraumatic stress disorder (PTSD) examination. He was diagnosed with unspecified depressive disorder. The Veteran reported that his second marriage had ended in divorce in March 2014 and he was in a new relationship for the previous year, but this relationship was strained. He was taking medication for his psychiatric symptoms. The Veteran reported symptoms of sadness, loss of interest in things he once enjoyed, decreased energy, concentration difficulties, and increased appetite. The examiner found symptoms of depressed mood, anxiety, chronic sleep impairment, mild memory loss, and difficulty establishing and maintaining effective work and social relationships. A March 2016 disability benefits questionnaire completed by a private physician states that the Veteran reported being divorced twice; that he had one adult child; that he was not in a relationship, and that he lived with his parents. The examiner stated that the Veteran was socially isolated and withdrawn. The examiner found symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty adapting to stressful circumstances including work or a worklike setting, and an inability to establish and maintain effective relationships. The Veteran reported that he could no longer enjoy even the simplest of activities. He had difficulty with short-term memory. He had no hallucinations, mood was anxious and nervous, affect was restricted, and he felt anxious and depressed. The examiner stated that he was vague with his responses, suspicious, and "seems rather paranoid when speaking with this examiner." The examiner indicated that, if employed, the Veteran would have to miss three or more days of work per month and would need to leave early from the workplace three or more times per month due to mental health problems. He would have three or more days per month when he would not be able to stay focused for at least seven hours of an eight hour workday due to psychiatric problems, and more than once per month he would respond in an angry manner to normal work pressures and constructive criticisms but would not actually become violent. In November 2016, the Veteran was afforded a VA mental disorders examination. The examiner diagnosed adjustment disorder with mixed anxiety and depressed mood and narcolepsy. The examiner was able to separate the narcolepsy symptoms from the other diagnosed disorders and service connection is in effect for narcolepsy so those symptoms are separately rated. The Veteran reported that he had no contact with his only child; lived with his mother, father, and stepfather in their house, and was his mother's caregiver; was in a relationship; was friends with his mother's friends; volunteered at church as a greeter; and for leisure did stick crafts and repaired solar powered lights. He also read the Bible. He attended two universities for a total of four to five semesters but did not obtain a degree. He worked for one day as a poll worker but otherwise had not worked since service separation. He was taking multiple psychiatric medications for his symptoms. The Veteran slept four to eight hours per night but awoke two or three times nightly. The Veteran reported no nightmares and his memory was good but he had to write things down. The Veteran reported his motivation was good but he had mood swings and was easily angered and frustrated. The Veteran reported avoiding crowds and not trusting others. The Veteran described his judgement as good "sometimes" but he was charged with domestic violence in 1997 and the charge was dismissed. He told the examiner that he would hear his mother calling his name when she did not call him and would see things out of the corner of his eye; showered twice a week; had a hard time adjusting to civilian systems; and he disliked when others were late. The examiner found symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment, flattened affect, and difficulty adapting to stressful circumstances including work or a worklike setting. His was adequately groomed. The examiner noted symptoms of feeling depressed three times per week; anhedonia which manifested as a desire to stay home and do less socializing; having adequate energy but requiring an occasional short nap. The examiner noted the Veteran's apparent report of having a good appetite. He also noted the Veteran had easy tearfulness and could show emotion but tried not to cry. The examiner also reported the Veteran had a high anxiety level but no panic attacks. In March 2021, the Veteran was afforded a VA mental disorders examination. He was diagnosed with chronic adjustment disorder. He apparently had remarried because he reported he lived with his spouse. He reported that he had some friends, but belonged to no organizations or clubs. The examiner found symptoms of depressed mood, anxiety, and disturbances of motivation and mood. He had adequate grooming and hygiene, denied suicidal and homicidal ideation, and denied hallucinations. VA treatment records throughout the period on appeal indicate symptoms of sadness; depression; anhedonia; decreased energy; decreased concentration; increased appetite; anxiety; irritability and angry outbursts; nightmares; hypervigilance; flashbacks; sleep impairment; frustration; and blunted affect. He reported no hallucinations, delusions, paranoia, or homicidal ideation. He had no suicidal ideation after his July 2012 hospitalization while in service. He was well groomed and hygiene was appropriate. He was married for the third time in 2017; was the caregiver for his mother until she died and for his spouse; and he and his spouse were raising his ex-step granddaughter. He had hobbies of coloring, stick crafts, color by number, and puzzles. The Veteran was taking prescription medication to treat his symptoms. Since October 24, 2013, the Veteran had occupational and social impairment with deficiencies in most areas. He was hospitalized a few months before service separation for suicidal ideation. He took classes some colleges for a few semesters but never graduated. He was married three times, lived with his parents for a while, and had no contact with his only child. He had a depressed mood, anxiety, memory loss, difficulty establishing and maintaining effective work and social relationships, flattened affect, anhedonia, was suspicious, seemed paranoid, was irritable and had angry outbursts, was isolated, avoided crowds, did not trust people, occasionally heard his mother calling when she had not and saw things out of the corner of his eye, had decreased concentration, nightmares, hypervigilance, and flashbacks. He took multiple psychiatric medications to control his symptoms. A 70 percent most closely approximates the Veteran's symptoms throughout the entire period on appeal. 38 C.F.R. § 4.7. However, a preponderance of the evidence is against a finding that the Veteran's symptoms most closely approximate a 100 percent rating. The Veteran did not have total occupational and social impairment. He went to church, sometimes participated in church activities, socialized with his mother's friends for a period, occasionally had a few hobbies, was able to serve as the caregiver for his mother and spouse, and was raising his ex-step-granddaughter. 2. Entitlement to an initial rating of more than 10 percent since October 24, 2013, for degenerative arthritis of the left patellar articular margin. Effective February 7, 2021, the ratings for knee disorders were changed. The Board finds that the prior ratings are more beneficial to the Veteran and will rate under the rating criteria in effect prior to February 7, 2021. The average normal range of motion of the knee is flexion from 0 to 140 degrees and extension from 140 to 0 degrees. 38 C.F.R. § 4.71, Plate II. Degenerative arthritis, established by X-ray, will be rated on the basis of limitation of motion under the appropriate diagnostic criteria for the specific joint or joints involved. When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent rating is warranted for X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups; a 20 percent rating is warranted if there are also occasional incapacitating exacerbations. Note (1) states: The 20 percent and 10 percent ratings based on X ray findings, above, will not be combined with ratings based on limitation of motion. Note (2) states: The 20 percent and 10 percent ratings based on X ray findings, above, will not be utilized in rating conditions listed under diagnostic codes 5013 to 5024, inclusive. 38 C.F.R. § 4.71a, Diagnostic Code 5003. Diagnostic Code 5257 provides ratings for recurrent subluxation or lateral instability. Slight disability warrants a 10 percent rating and a moderate disability warrants a 20 percent rating. Severe disability warrants a 30 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Diagnostic Code 5258 provides that a 20 percent rating is warranted for dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. 38 C.F.R. § 4.71a, Diagnostic Code 5258. Diagnostic Code 5259 provides that a 10 percent rating is warranted for symptomatic removal of semilunar cartilage. 38 C.F.R. § 4.71a, Diagnostic Code 5259. Diagnostic Code 5260 provides ratings based on limitation of flexion of the leg. Limitation of flexion to 60 degrees warrants a noncompensable rating. Limitation of flexion to 45 degrees warrants a 10 percent rating. Flexion limited to 30 degrees warrants a 20 percent rating. Flexion limited to 15 degrees warrants a 30 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Diagnostic Code 5261 provides ratings based on limitation of the extension of the leg. Limitation of extension to 5 degrees warrants a noncompensable rating. Extension limited to 10 degrees warrants a 10 percent rating. Extension limited to 15 degrees warrants a 20 percent rating. Extension limited to 20 degrees warrants a 30 percent rating. Extension limited to 30 degrees warrants a 40 percent rating. Extension limited to 45 degrees warrants a 50 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5261. In November 2012, prior to service separation, the Veteran was afforded a VA examination. The Veteran reported retropatellar knee pain when using the stairs. The examiner found pain, stiffness, and that his disorder affected the motion of the joint. He was able to stand for more than 1 but less than 3 hours and able to walk 1 to 3 miles. He frequently used a brace. The examiner also found crepitation, grinding, flexion to 140 degrees, extension to 0 degrees, and no additional pain or limitation following repeated use. The November 2012 examination report noted that a March 2007 X-ray study indicated mild degenerative changes of the patellar articular margin. In April 2015, the Veteran was afforded another VA examination. He was diagnosed with degenerative joint disease (DJD), patellofemoral pain syndrome, and loose bodies in the joint. The Veteran reported flare-ups resulting in increased pain approximately every 2 weeks if he was frequently using the stairs, but no functional impairment or loss. The examiner found flexion to 140 degrees with pain and extension to 0 degrees. There was pain on palpation of the medial and lateral joint lines and no pain on weight-bearing, no crepitus, and no additional functional loss or loss of range of motion after three repetitions. The examiner indicated that he was unable to say without resort to speculation whether there was additional loss of range of motion following repeated use over time or during a flare-up. This fails to comply with Sharp v. Shulkin, 29 Vet. App. 26 (2017) and, therefore, this portion of the examination is inadequate. The examiner found no ankylosis, recurrent subluxation, lateral instability, recurrent effusion, or meniscus condition. The Veteran used no assistive devices. An X-ray study indicated small loose bodies present in the posterior joint space and osteoarthritis. In November 2016, the Veteran was afforded another VA examination. He was diagnosed with degenerative arthritis. The Veteran reported pain when using the stairs, when walking on uneven ground, or when bending or squatting. He reported daily dull, aching pain which increased during flare-ups to sharp pain at a 6 out of 10 on the pain scale. Rest and elevation would bring his knee pain to a 4 out of 10. He reported flare-ups and functional loss. The examiner found flexion to 140 degrees with pain and extension to 0 degrees. There was no pain with weight bearing and no crepitus. He had pain on palpation. The examiner noted with very light palpation there was a high degree of symptom magnification on range of motion testing. He had no additional functional loss or loss of range of motion following repetitive use testing. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability following repetitive use over time or during flare-ups. Muscle strength testing was normal and there was no muscle atrophy and no ankylosis. There was no recurrent subluxation, lateral instability, or recurrent effusion. He occasionally used a brace and a cane for locomotion. VA treatment records throughout the period on appeal indicate symptoms of pain, crepitus, degenerative changes, osteophyte formation, narrowing of the medial joint space, small loose bodies at the posterior aspect of the knee, lateral tracking of the patella, near falls, feeling of instability, grinding, flexion to 123 degrees, extension to 0 degrees, and decreased muscle strength. The Veteran took prescription pain medication for his knee symptoms, including opioid medication, and received cortisone injections. Given these facts, a 10 percent rating is warranted for instability under diagnostic code 5257. A preponderance of the evidence is against a finding that a rating of 20 percent or higher is warranted for instability or recurrent subluxation. Neither instability nor subluxation were detectable on any VA examination and, therefore, there is no indication the feelings of instability were any more than slight. A preponderance of the evidence is also against a finding that a rating of more than 10 percent is warranted for arthritis. Diagnostic code 5003 states that when limitation of motion is noncompensable, a 10 percent rating is for application. The Veteran had normal range of motion at each of his VA examinations. One VA treatment record indicated flexion to 123 degrees. There is no evidence, however, of limitation of flexion to 45 degrees such that a 10 percent rating would be warranted under diagnostic code 5260. There is also no evidence that the Veteran had limitation of extension at any time such that a compensable rating would be warranted under diagnostic code 5261. Therefore, because the limitation of motion is noncompensable, the Veteran's disability is appropriately rated at 10 percent for arthritis according to diagnostic code 5003. See 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5260, 5261. The 10 percent for instability and the 10 percent for arthritis with noncompensable limitation of motion adequately reflect the Veteran's left knee limitation of motion and functional impairment since October 24, 2013. 38 C.F.R. § 4.7. See Hart v. Mansfield, 21 Vet. App. 505 (2007). In making these determinations, the Board has considered, along with the schedular criteria, the Veteran's functional loss due to pain. 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202, 206-207 (1995). The Board has considered that a portion of the April 2015 VA examination is inadequate because the examiner failed to comply with Sharp, 29 Vet. App. at 26. However, the subsequent examination in November 2016 indicated similar symptoms and the same range of motion as the April 2015 examination. That examination found that pain, weakness, fatigability, or incoordination did not significantly limit functional ability following repetitive use over time or during flare-ups and, therefore, that examination complied with Sharp. Remand for a new examination is not necessary because an adequate examination followed the inadequate one. 3. Entitlement to TDIU. TDIU may be assigned, where the schedular rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. If there is only one such disability, that disability must be ratable at 60 percent or more. If there are two or more disabilities, there must be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). The Veteran is now rated 70 percent for adjustment disorder, 30 percent for left (minor) shoulder partial thickness supraspinatus tear, 30 percent for asthma, 20 percent for left peroneus brevis tear, 10 percent for degenerative arthritis of the left patellar articular margin, 10 percent for left knee instability, 10 percent for left foot tendinopathy status-post repair, 10 percent for narcolepsy, and noncompensable ratings for atypical chest pain, small hepatic cyst, left ankle scar, and left peroneus brevis tear surgical scar. The Veteran has an overall rating of more than 90 percent and meets the schedular criteria for TDIU. The record indicates that the Veteran has not worked since separation from service in October 2013. He was found to be able to be rehabilitated for employment under the VA VR&E program until May 2014. He was subsequently enrolled at a university in 2015 and 2016 but did not complete a degree program. There is no evidence that he has pursued educational opportunities since 2016 or has been found to be able to be rehabilitated for employment since his VR&E benefits were terminated in May 2014. A spring 2016 Student Academic Accomodation Request Form from the university he was enrolled at indicated that he "may require frequent breaks; may leave class abruptly." Given the severity of the Veteran's psychiatric disorder, combined with his physical disabilities, including restrictions on lifting due to the left shoulder disorder, several left lower extremity disabilities and impairment, difficulty staying awake due to his narcolepsy, and breathing difficulties due to the asthma, the Board finds that the Veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. TDIU is granted. REASONS FOR REMAND 1. The issue of an effective date prior to October 24, 2013, for the grant of service connection for left shoulder (minor) partial thickness supraspinatus tear is remanded. 2. The issue of an effective date prior to October 24, 2013, for the grant of service connection for left peroneus brevis tear is remanded. 3. The issue of an effective date prior to October 24, 2013, for the grant of service connection for narcolepsy without cataplexy is remanded. 4. The issue of an effective date prior to October 24, 2013, for the grant of service connection for adjustment disorder is remanded. 5. The issue of an effective date prior to October 24, 2013, for the grant of service connection for degenerative arthritis of the left patellar articular margin is remanded. 6. The issue of an effective date prior to October 24, 2013, for the grant of service connection for atypical chest pain is remanded. 7. The issue of an effective date prior to October 24, 2013, for the grant of service connection for small hepatic cyst is remanded. 8. The issue of an effective date prior to October 24, 2013, for the grant of service connection for left ankle scar is remanded. The matters are REMANDED for the following action: In a January 2014 rating decision, the RO granted service connection for left shoulder (minor) partial thickness tear, left peroneus brevis tear, narcolepsy without cataplexy, adjustment disorder, degenerative arthritis of the left patellar articular margin, atypical chest pain, small hepatic cyst, and a left ankle scar. On the May 2014 notice of disagreement (NOD), the Veteran checked the form's boxes indicating that he wished to appeal both the initial rating assigned and the effective date of the grant of service connection. A statement of the case (SOC) addressing the effective dates of the grants of service connection has not been issued. Therefore, remand is necessary for the RO to issue an SOC to the Veteran and his accredited representative. See Manlincon v. West, 12 Vet. App. 238, 240-241 (1999). The Veteran should be given the appropriate opportunity to respond to the SOC. Vito A. Clementi Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. E. Miller, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.